The war was over - but Spanish Flu would kill millions more

On Armistice Day 1918 Britain was in the grip of Spanish Flu, which could kill its victims in less than a day. But few foresaw its terrible consequences, says Juliet Nicolson.

Armistice Day in London in 1918Photo: Getty

By Juliet Nicolson

7:45AM GMT 11 Nov 2009

In the months that led up to the November 11 Armistice of 1918, the world's armies and navies had begun to disperse. On their way home, the demobilised took with them a virulent virus.

The fetid, rat-rich, body-rotting trenches provided ideal breeding grounds for the virus that would be responsible for more than five times as many deaths as the war itself. The virus was thought to have originated in chickens and mutated in pigs before emerging in humans in the spring of 1918.

In the autumn, the nation was struggling to come to terms with the catastrophe of the First World War. Nearly three quarters of a million British men were estimated to have died and more than a million and a half had been severely wounded during the conflict. Almost no surviving individual escaped the grief of losing a husband, father, son, fiancé, uncle, cousin or friend.

Nine decades on, we are preparing for a winter in which swine flu may mutate into a widespread killer. It is undeniably an unpleasant disease – sufferers tell of agonising sore throats, sheet-drenching sweats, uncontrollable vomiting, and a lethargy that confines you to bed for a full week – but the 1918-1919 influenza virus that swept the world was even nastier.

Those afflicted were first aware of a shivery twinge at breakfast. By lunchtime, their skin had turned a vivid purple, the colour of amethyst or the sinisterly beautiful shade of the heliotrope flower. By the evening, before there was time to lay the table for supper, death would have occurred, often caused by choking on the thick scarlet jelly that suddenly clogged the lungs. Between 50 and 100 million people across the world died of what became known as Spanish Flu.

Just as the current flu epidemic seems to have concentrated on attacking the young, so in 1918-1919 the 15-40 year-olds were the most susceptible. The death toll included those who had survived the war but had not lived long enough to develop the immunities acquired during previous flu epidemics by members of older generations.

A loving embrace exchanged at the end of the war between two people who may not have seen each other for several years risked the immediate transfer of the disease. The huge crowds that attended the Armistice celebrations in Trafalgar Square in London and hundreds of communal spaces up and down the country intensified the chances of the disease spreading.

At the beginning of the outbreak, in the summer of 1918, the Royal College of Physicians announced that this strain of flu was no more threatening than the still well-remembered virus of 1890. And it is hardly surprising that a press wearied by the relentless coverage of so much mortality during the preceding years should be reluctant to give this new killer much publicity. The Times even suggested that the swift spread of the epidemic might have been a direct result of "the general weakness of nerve-power known as war-weariness".

A browse through that autumn's newspapers confirms the post-war conclusion of the poet T S Eliot that "humankind cannot bear very much reality". Stories of the new epidemic were buried deep within papers, often at the bottom of the page. The General Medical Council discouraged the use of the word "pandemic" but the escalating death rate was impossible to ignore, swelling the increasing fear of the disease. Some countries introduced legislation that now seems less far-fetched than at the beginning of this year. In Arizona they outlawed handshaking; in France, spitting became a legal offence.

While researching the illustrations for a new book set just after the end of the Great War, I came across photographs of Londoners going about their business, their noses and mouths bandaged against catching the infection. The pictures seemed as alarmist as those of Michael Jackson's masked children on holiday. Perhaps the sight was not so arresting to Britons in 1919, when the virus reached its peak. Demobbed soldiers had been walking through the streets for a year or two wearing masks that concealed the dreadful, inoperable facial injuries inflicted in trench warfare. The flu epidemic propelled thousands more to adopt the practice.

Medical advice was scant. Most doctors were still out at the front treating war casualties, with the majority of nurses (salaried and voluntary) in attendance. At home, an estimated three nurses were available per million of population. Six nurses at Great Ormond Street Hospital alone had died of the flu in a few months. And influenza victims took second priority to the 10,000 wounded and shell-shocked men who continued to occupy hospital beds for months after the ceasefire.

In 1918, no Tamiflu-type medical antidote was available, nor any prospect of a mass vaccination. The General Medical Council was challenged to come up with practical remedies. A small gauze mask made from three layers of butter muslin and worn across the mouth and nose seemed to inhibit the virus.

Doctors dispensed alternating suggestions either for rejecting all alcoholic beverages or for taking regular tots of whisky, the age-old remedy for all ills, including fear itself. Some recommended half a bottle of light wine a day, as well as a glass of port before retiring to bed after a very hot bath. Tobacco was generally thought to exacerbate the illness and was mildly discouraged. Oxo spent millions on advertising its meaty drink supplement as a good way of increasing nutrition and "fortifying the system".

Huge numbers of the influenza-suffering public relied on their own resources. Older people fell back on trusted household remedies for illness: laudanum, opium, quinine, rhubarb, treacle and vinegar were all invested with special healing powers.

But none of these antidotes provided an infallible cure and the authorities struggled as the epidemic took hold. In London, nearly 1,500 policemen, a third of the force, reported sick simultaneously. Council office workers took off their suits and ties to dig graves. Coffins that had been stockpiled during the war (a wartime agreement had been made that no bodies would be brought back from the battle lines) were suddenly in short supply. Railway workshops turned to coffin manufacturing and Red Cross ambulances became hearses.

Whole classes of children were kept away from school by their wary parents, filling instead the city's playgrounds and singing

I had a little bird

Its name was Enza,

I opened the Window

And in-flew Enza.

For those who overcame the illness, among them Winston Churchill's wife Clementine and their youngest daughter Marigold (although their Scottish nanny perished), a lingering sense of depression led some to take their own lives. James Shaw, a crane driver from Newham in London Docklands, recognised the symptoms and knew that without his wage there would be no money to look after his daughters, Lucy, aged seven, and Edith May, two and a half. So he took his safety razor and cut Edith May's throat. Lucy wriggled from under him as he was halfway through the job and ran away bleeding.

Worn out by the war that he had thought would never end and with all hope for a happy future destroyed by an illness that had almost certainly come to destroy him, James Shaw put the razor to his own throat.

To cheer themselves up, people went to the cinema. Lillian Gish with her fragile beauty was the most popular film star of the year. Her name had been adopted at Billingsgate fish market as part of the traders' rhyming slang, crying: "Fancy a nice bit of Lillian for your supper tonight?"

Arriving from a bus liberally sprayed with disinfectant, people settled down to watch the latest Gish weepie, Broken Blossoms, sometimes spending the whole day in the cinema, as reel followed reel. Councils insisted cinemas be emptied every four hours to allow windows to be opened to aerate halls, but the manager of the Coronet in Notting Hill refused to disturb his customers. He claimed his special aerating machine still worked while the audience remained in their seats. The bug-ridden air was never given a chance to escape and the infection was redistributed around the auditorium.

Some responses to the epidemic were equally restrained. The Savoy Hotel announced that it was in the grip of the charmingly named "Big Sneeze", reporting that at a recent lunch party of five millionaires, only two had turned up. The chemist in the Strand opposite the hotel sold more quinine in one day than in the previous three years. But the barman at the hotel, always up for a challenge, invented a cheery new cocktail based on whisky and rum, and called it a Corpse Reviver.

Throughout the 1918-1919 epidemic, the British remained resilient, giving and receiving the same advice they had followed for the preceding four years: there seemed then to be no alternative to simply "carrying on". And even now, with all the advances medicine has made, no one has come up with a better suggestion.

'The Great Silence' 1918-1920, Living in the Shadow of the Great War' by Juliet Nicolson is published by John Murray, £20